Corneal abrasion
A scratch on the cornea, usually healing within three days.
A corneal abrasion is a scratch on the eye's surface, causing pain, redness, light sensitivity, and a feeling of something in the eye. Most heal fully within three days, but complications like infection or ulcer occur in up to 10% of people.
Quick Facts
- Field
- Ophthalmology, emergency medicine
- Symptoms
- Eye pain, light sensitivity
- Onset
- Rapid
- Duration
- Less than 3 days
- Causes
- Minor trauma, contact lens use
- Diagnosis
- Slit lamp exam
- Differential
- Corneal ulcer, globe rupture
- Prevention
- Eye protection
Facts from the source article.
Signs and symptoms
Pain, trouble with bright lights, a foreign-body sensation, excessive squinting, and reflex production of tears are common. Signs include epithelial defects, edema, and redness of the eye. Vision may be blurred from corneal swelling or excess tears. Crusty buildup from excess tears may also be present. Complications are the exception rather than the rule. Occasionally the healed epithelium may detach, giving rise to recurrent corneal erosions.
Causes
Corneal abrasions generally result from trauma to the eye surface, such as being poked by a finger, walking into a tree branch, or wearing old contact lenses. A foreign body in the eye may cause a scratch if the eye is rubbed. Hard or soft contact lenses left in too long can cause injury, sometimes upon removal. A dry cornea becomes more brittle and easily damaged. Soft contact lens wear overnight is linked to gram negative keratitis, particularly by Pseudomonas aeruginosa, which forms in the eye's biofilm. An injured cornea in a contact lens user is much more susceptible to this infection, an optical emergency that can threaten sight or the eye itself. Contact lens wearers with corneal abrasions should never be pressure patched, as patching creates a warm, moist, dark environment that can accelerate infection. Corneal abrasions are also recurrent in people with lattice corneal dystrophy, where amyloid deposits accumulate in the stroma, appearing as clear, comma-shaped overlapping dots and branching filaments. Over time, these lines grow opaque and converge, clouding the cornea. When deposits accumulate under the epithelium, they can cause recurrent epithelial erosion, altering the cornea's curvature and exposing nerves, causing severe pain.
Prevention
The best way to stop a corneal abrasion from coming back is to prevent it in the first place. Anyone handling dangerous machinery, metal, wood, or chemicals, or doing yard work or contact sports, should wear protective eyewear. Options include polycarbonate goggles, plastic safety glasses, face shields, and welding helmets. Welders need a helmet with a UV-blocking lens to prevent UV keratitis. People who have only one functioning eye face a higher risk of severe injury and must be especially diligent about eye protection. For contact lens wearers, a good fit and careful hygiene are key. Use effective disinfecting solutions, antimicrobial lenses and cases, and never swim while wearing contacts, as this raises the risk of bacterial infection. Finally, do not wear contacts longer than their recommended replacement schedule.
Treatment
When a corneal abrasion occurs, the main goals are to stop infection, support healing, and ease discomfort. Any foreign object must be taken out. The patient lies down with the injured eye facing the doctor, and stares at a fixed ceiling spot to center the object. Numbing drops, typically oxybuprocaine 0.4%, are placed in both eyes to control eyelid spasms. A pupil-dilating drop like cyclopentolate 1% may help with eye muscle cramps after removal, but atropine is not used because its effects last too long. Finally, the eye and its inner lids are rinsed with sterile saline to clear away any leftover debris.
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